The Austrian surgeon, Theodor Billroth (1829-1894), is generally regarded as the founding father of modern abdominal surgery. The Austrian physician, Karl Landsteiner (1868-1943), is noted for his development in 1901 of the modern system of classification of blood groups. In early 1840s surgery began to change dramatically in character with the discovery of effective and practical anesthetic chemicals such as ether and chloroform. And cases related to the appendix opened doors to abdominal surgeries allowing causes to become discovered and ways to performing better surgeries.
These contributions were directly the landmarks in the development of surgery. Historically, the earliest known surgical procedure was trepanation, in which a hole is drilled into the skull leaving the membrane around the brain intact. It has been carried out for both medical reasons and mystical practices for a long time, dating back to Hippocrates who even gave specific directions on the procedure from its evolution through the Greek age. The Edwin Smith papyrus is the oldest known surgical text, dating back to the 1600s BC.
Today, this is an ancient Egyptian textbook on surgery, and describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments. Surgeons are now considered to be specialized physicians, although initially physicians and surgeons had different historical roots. For example, the Hippocratic Oath warned physicians against the practice of surgery. By the 13th century, many European towns were demanding that physicians have several years of training before they could practice.
And during that time, surgery had a lower status than pure medicine. Among the first modern surgeons were battlefield doctors who were primarily concerned with amputation. In the 18th century, five main surgeries were laid out by Bell: Aneurysm, Amputation, Bladder stone, Trepanation, and Hernia. All of these do not require the opening of the abdomen/chest as this was the limit of surgery. Progressively, physicians realized that an essential part of surgery was speed. In 1846 marked the changing point in surgery.
During this time, physicians were able to put their patients to sleep before performing surgery and therefore physicians would be able to take their time. Also, surgeries became much less painful after this year; and it opened many doors to new kinds of patients who had a choice. It allowed growth for medical professions as well (ie. McGill offers MDCG). In 1863, General Surgical Pathology and Therapeutics (tr. from German), Theodor Billroth (1829-1894) voiced his opinion about surgeons had to be physicians and vice-versa.
He emphasized both physicians and surgeons needed to have the same knowledge. He reasoned his opinion saying knowing medical state of a patient was important for any surgery. It was during this time that finally the prestige of surgery began to increase. Blood loss was a big loss for surgery; and the idea that this can be prevented by tying vessels was introduced by F. Esmarch. He was a military surgeon who proposed the idea that when a surgery is performed in a part that has blood coming out from two arteries, these arteries can be “clamped” to reduce blood loss.
From William Harvery’s time (1578-1657), people thought physicians can transfuse blood (replace it) from other sources (ie. Dogs, etc. ); this notion was corrected by Theodor Billroth. In his book (New York, 1886), Billroth talks about statistics which was fairly a new concept and he modified the idea of transfusion and attempted to put blood from one human into another human. It was the first time the concept of different blood groups appear in different people was introduced. He said that one person may have a blood group similar to another person.
However, it was Karl Landsteiner (1868-1943) who went on to say there were four groups of blood, as we know it today: A, B, AB, O. Karl Landsteiner investigated blood groups in an attempt to find which group of blood he was able to put together. This was a landmark in the development of surgery as it removed the danger of transfusion that was previously present. Now it is used with care. Before the advent of anesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize the patient suffering.
In the past, alcohol and coco-plants were used as anesthetic but these were not effective in reducing pain during surgery; therefore surgery was not normally performed. In fact, this meant that operations were largely restricted to amputations and external growth removals. The need for strict hygiene during procedures was little understood, which often resulted in life threatening post-operative infections in patients. People tried various ways to anesthetize by experimenting. N2O (laughing gas) was widely used, a diary of an opium eater showed that a person could describe the dreams he would have.
The discovery of N2O was truly by Americans used in the field of dentistry. Perhaps this discovery was one of the first to bring recognition of America to rest of the world. Sulfuric Ether by Jackson of Harvard University who suggested it was introduced by Henry Bigelow (1818-1890). The invention of Ether resulted in the application to use which has a side effect of relaxing muscles making operations much easier. It is not yet certain who the real founder of Ether was; however, Crawford Long (1815-1878) swore by David and tried to convince everyone that he was the real founder of Ether.
He tells this through his experience in use of ether way before anyone else has ever thought of it. The changing point in surgery was in 1846; it was then that surgery became less painful. Noting that ether isn’t too good for use in reality, James Simpson (1811-1870) introduced in his book “Account of a New Anesthetic Agent as a Substitute for Sulfuric Ether” which was chloroform. Although chloroform can cause liver damage, both ether and chloroform can be administered safely if they’re given in the right amount.
Hence, in addition to relieving patient suffering, anesthesia allowed more intricate operations in the internal regions of the human body. Before 19th century, people didn’t know exactly what was happening inside of the body, but knew there was some form of twisting. The idea of “ileus” (twisting) dates back to Hippocratic times. Therefore, the interest to know what was happening inside greatly increased in furthering surgery. Vermiform appendix of the caecum was discovered in the 16th century by the Romans. One of the most common disease of the appendix (in humans) is appendicitis.
However, in 1756 a physician received a man who had a condition of a pin in the appendix. During that time the condition was not operable but the physician somehow managed to treat it anyways. This created curiosity for appendicitis conditions and abdominal surgeries. Richard Bright (1789-1858) and Thomas Addison (1793-1860) introduced ways to treat inflammation of the caecum and appendix vermiforms. They initiated the idea of having a surgery done sooner than later. And used an approach which was based on wait and see.
In fact, their work in “Elements of the Practice of Medicine” (London, 1839) was the first to show a clinical treatment of appendicitis; therefore it was the initial point in surgery when people began to treat such conditions. Later on this was modified further and was more modern. The real pioneer of abdominal operation, however, was bought by Hermann Kriege. He performed a surgery which showed that understanding of surgery was becoming very clear and diagnosis becoming fine. In the past, everything relating to abdominal surgery was vague.
Although, there is no clear mentioning by Kriege of how clean the instruments used were it can be seen that all the causes are being discovered. In conclusion, the move to longer operations increased danger of dangerous complications since the prolonged exposure of surgical wounds to the open air increased chances of infections. It was only in the late 19th century with the rise of microbiology, scientists like Louis Pasteur (1833-1895) and innovative doctors were able to implement the notion of strict cleanliness and need for sterile settings during surgery arise.